BF.7 Omicron subvariant in India and China: a raising concern – correspondence
Authors: Ranjit Sah, Aroop Mohanty, Ranjana Rohilla, Bijay K. Padhi
Journal: International Journal of Surgery (2023)

Highlights Covid-19 cases has been increased in China and India because of BF.7 Omicron sub-variant. R0 i.e., basic reproduction number of BF.7 Omicron sub-variant is 10 to 18.6, whereas Delta variant had RO of 5 to 6 approximately BF.7 is being reported from 91 countries like USA, UK, Europe, South Korea, Brazil, and India Dear Editor, There has been a recent outburst of coronavirus disease 2019 (COVID-19) cases in China because of the BF.7 Omicron subvariant. The massive crisis started after 'Zero COVID policy' in place since the first wave in 2019 was refuted; people were susceptible as herd immunity had not developed owing to stringent lockdown measures. The health care facilities are overfilled with cases, while crematoriums have long lines for the last rites of deceased family members. BF.7 cases have been reported in the USA and Europe since October. Experts have made projections that the situation in China will get worse by March 2022. BF.7 is known to re-infect frequently and also infect the vaccinated population. Its R0, that is, the basic reproduction number, is 10–18.6, whereas the Delta variant had an R Nought of ~5–61. BF.7 is being reported from 91 countries, including the USA, UK, Europe, South Korea, Brazil and India. India has started screening international passengers for COVID-19 at airports. As per the Cabinet Health Minister, the government might make testing for all international arrivals mandatory, if needed. Till now, India has four confirmed cases of the BA.5.2.1.7, that is, the BF.7 subvariant of Omicron: three in the state of Gujarat and one in Odisha in the east. BF.7 has a short incubation period; it has potential to spread fast. The Prime Minister of India summoned a high-level meeting on 22 December 2022, to assess the COVID-19 situation and stressed the need arrange for adequate infrastructure, medicines, ventilators and oxygen supplies. After reignited surge in COVID-19 cases in China, people were requested to wear masks, and get booster vaccination if needed. As many as 185 new Coronavirus cases have been reported on 22 December 2022, in India, with four cases proven to have the BF.7 subvariant. Direct flights from China have been banned, yet there are connecting flights from neighbouring countries like Sri Lanka, Nepal and Myanmar. WHO is very concerned about an unprecedented wave of cases in China, which might impact other countries soon2. The Health Ministry of India ordered to escalate testing samples from suspected cases and also to ensure that all positive samples are sent for genome sequencing to 50 sequencing laboratories set up under INSACOG (Indian SARS-CoV2 Genomics Consortium). INSACOG was set up in the year 2020 to monitor various COVID virus variants circulating in the country. Early isolation, detection and timely management of cases are of crucial importance to curb the outbreaks. Keeping in view the upcoming 'New Year', government can announce new guidelines for passengers travelling in and outside the country3. Genome sequencing can help avoid a wave similar to the second wave; the delta variant had spread at that time and nearly collapsed the Indian health care infrastructure in the year 2021. Positive samples retrieved from airports will be sequenced within 48 hours by INSACOG Laboratories. This will prove instrumental in mapping COVID-19 in the country. The expanding genome sequencing facilities will aid immensely in policy formulation to fight back the infections. India will impose airport testing and home quarantine, even for completely vaccinated individuals arriving in the country from areas with Omicron cases. The National Institute of Virology, Pune, India, will also put in efforts to isolate Omicron to help the 'Bharat Biotech International' and 'the Serum Institute of India', the two vaccine manufacturing giants of India, make vaccines for the new subvariant. An advisory has already been issued against mass gatherings. India had suffered much during the second wave of COVID-19, which killed at least 500 000 people and infected nearly 40 million people. The dynamics of the second wave in the country were a lesson for administration, the public and scientific organisations like the Indian Council of Medical Research that have helped draught policies to combat such pandemics so that India should never suffer through similar things again2. The country is more prepared compared to the last time if similar upsurge is observed in India. Caseload is still low in India, and more efforts can be put into the sequencing and surveillance of the cases for the time being. Apart from that, lags in reporting that are not happening in real time are concerning; therefore, more efforts are required to avoid such lags so as to isolate infectious cases in a timely manner4. Ethical approval Not applicable. Sources of funding None. Authors contribution R.S., A.M., R.R. and B.K.P. developed the original draft, review and edit the manuscript. All authors read and approve for the final manuscript. Conflict of interest disclosure None. Research registration unique identifying number (UIN) 1. Name of the registry: NA. 2. Unique identifying number or registration ID: NA. 3. Hyperlink to your specific registration (must be publicly accessible and will be checked): NA. Guarantor Ranjit Sah. Data availability All data are included in the manuscript.